Diabetes Group of 7

Diabetes is a disease that affects 2.25 million Canadians and 20.8 million Americans. Type 1 diabetes occurs when the body cannot produce insulin. Type 2 diabetes occurs when the body becomes resistant to insulin, and cannot make enough insulin to overcome this resistance. Diabetes is the sixth leading cause of death in the United States and the seventh leading cause of death and disability in Canada. Furthermore, adults with diabetes are twice as likely to face an early grave compared to those without the disease. However, most of the harmful complications caused by diabetes can be prevented.

The Diabetes Group of 7 is a Canadian group formed in early 2006 to educate people about diabetes and about the common misconceptions regarding diabetes treatment. The group has seven members, including healthcare experts, people living with diabetes, and their family members. The group's motto, "Life is Better Under 7," is inspired by the Canadian Diabetes Association's recommendation that diabetes patients should maintain a blood glucose level (A1C) of 7% or less. In order to spread their message, members of the Group of 7 have conducted interviews with newspapers, television stations, and radio stations across Canada.

The Problem of Denial

Consistently high blood glucose levels are responsible for most of the complications resulting from diabetes, which can include blindness, nerve damage, kidney failure, heart disease, and stroke. Yet in 2005, the Diabetes in Canada Evaluation (DICE) survey revealed that half of all Canadians living with type 2 diabetes did not have their blood glucose levels under control.

According to Diabetes Group of 7 member Carolyn Lawton, a nurse practitioner who specializes in diabetes, many newly-diagnosed people with type 2 diabetes are in denial about their condition. "Since they don't feel different," she said, "they find it hard to accept that they have a disease." They do not make the necessary lifestyle changes to keep their blood glucose low, and are often resistant to using insulin as part of their therapy. But because people with type 2 diabetes may have had abnormal blood glucose levels for years before they are diagnosed, it is urgent for these patients to get their blood glucose under control. Dr. Ian Blumer, a member of the executive of the Clinical and Scientific Section of the Canadian Diabetes Association says that, "high levels of blood glucose is like a toxin circulating in the blood," and people with newly-diagnosed diabetes need to achieve an A1C of 7% within six to 12 months.

The Need for Lifestyle Changes

Once past the initial stage of denial, patients must make and maintain significant lifestyle changes. Both Blumer and Lawton emphasize the fact that patients must be empowered and given the tools to look after themselves. These tools include regular blood glucose checks, maintaining a healthy body mass index (BMI), regular exercise, and a healthy diet with appropriate amounts of carbohydrates, proteins, and fats.

Blumer said that patients often feel guilty for "cheating" on their diet, but says that it isn't cheating, it's only an occasional indulgence. "Diabetes is not a punishment!" he insisted. "It's still OK to have ice cream or apple pie, just in small quantities and not everyday."

Coleman Romalis, who is a member of the group and who has type 1 diabetes, said that thanks to staying active and paying attention to the food he eats, he's "healthier and fitter" now than before his diagnosis 12 years ago. "This is not something that I could have accomplished on my own," Romalis added. "From the moment of my diagnosis, I've been very lucky in having superb medical care, as well as an observant and supportive family."

The Case for More Insulin

Typically, medications are used to complement diet and exercise. Since their own bodies are unable to make the hormone, people with type 1 diabetes must remain on insulin treatment.

People with type 2 diabetes are prescribed oral medications such as metformin, glyburide, Actos, or Avandia if diet and exercise alone are insufficient to lower their blood glucose levels. Insulin can also be a powerful tool in managing type 2 diabetes, but according to Blumer, it is terribly under-utilized. Blumer said that about 40% of people with type 2 diabetes use insulin at some point during their lifetime, but the number of patients who should be using it is probably 80% or more. "The enemy is not insulin," Lawton stresses, "it's the elevated blood sugars." She went on to state that most patients with type 2 diabetes consider insulin as "the end of the line," and will use it only when the maximum dose of oral medications is no longer sufficient to control their blood glucose.

Blumer refers to this phenomenon as "therapeutic inertia," and states that both physicians and patients are responsible. He said that doctors need to be more proactive in explaining insulin and its benefits, and patients need to become informed about the realities of modern insulin treatment. Many patients still harbor fears and misconceptions about insulin, citing painful injection and harmful side effects as reasons for their reluctance to use it.

However, Blumer emphasized that many of these perceptions are based on outdated or incorrect information. For example, current needles are tiny and cause virtually no pain upon injection, and Romalis, who injects insulin at least four times a day, says that "pen needles are very discreet and easy to use." According to Blumer, "insulin has been around for 85 years, and accurate blood glucose measurement devices have only been around for 25 years." Therefore, complications were more likely to occur when patients were unable to determine how much insulin to inject to match their body's needs. Today's patients have access to precise blood glucose testing equipment and can therefore exactly measure the amount of insulin their body needs.

Beyond Diabetes

In addition to maintaining healthy blood glucose levels from day to day, both Blumer and Lawton emphasized that patients should see their doctor regularly. Blood pressure and cholesterol level checks, along with regular screening for diabetes-related health complications are all an essential part of patient care. They also stress that healthcare professionals, especially general practitioners, must become better informed about diabetes and all of its treatment options.

Seven percent of all Canadians and Americans are living with diabetes. Although there is still no cure, the knowledge and tools are readily available to help patients lead longer and healthier lives.

Dr. Ian Blumer is a member of the executive of the Clinical and Scientific Section of the Canadian Diabetes Association, and a director at the Charles H. Best Diabetes Centre. He is the author of the book Diabetes for Canadians for Dummies, and maintains a website called Rule Your Diabetes.

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